The optimal screening strategy for chronic hepatitis B virus infection in China
Authors: Jue Liu, Min Liu
Journal: The Lancet Global Health (2022)

Shu Su and colleagues (February, 2022),1Su S Wong WC Zou Z et al.Cost-effectiveness of universal screening for chronic hepatitis B virus infection in China: an economic evaluation.Lancet Glob Health. 2022; 10: e278-e287Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar in their Article on the cost-effectiveness of universal screening for chronic hepatitis B virus (HBV) infection in China, found that the five-test universal screening strategy in people aged 18–70 years, implemented within the next 10 years, is the optimal HBV screening strategy for China. To identify optimal screening strategies in China, further analysis and elaboration by Su and colleagues on comparing the screening strategy of key groups or groups at high risk with universal screening strategy would be necessary. China is a populous country with 1·4 billion people; for this reason and others, a universal screening strategy for a disease is rare and difficult to implement in China and globally. However, Su and colleagues just simulated universal HBV screening to target age subgroups between 18 and 70 years. Strategies for key groups or groups at high risk have been commonly and successfully used in the prevention and control of infectious diseases and chronic diseases in China.2Zou Z Fairley CK Ong JJ et al.Domestic HPV vaccine price and economic returns for cervical cancer prevention in China: a cost-effectiveness analysis.Lancet Glob Health. 2020; 8: e1335-e1344Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar Compared with the strategy used for screening of key groups and groups at high risk, the universal screening strategy might not be the best choice given the potential cost, required human resources, current available medical health resources, and the subsequent need for health-care services. Another concern is that individuals aged 0–17 years, which is an important age group, are not considered in this study. It is well known that, compared with adults, children have a higher risk of poor prognosis if infected with HBV.3Liu J Liang W Jing W Liu M Countdown to 2030: eliminating hepatitis B disease, China.Bull World Health Organ. 2019; 97: 230-238Crossref PubMed Scopus (153) Google Scholar Why did the authors exclude this age group? Moreover, the discrimination, ethics, psychology, and sociological problems of newly screened patients should also be fully considered, given the potentially untimely treatment following the universal screening in resource-scarce areas.4Liu W Xia Y Hou J Health expenditure efficiency in rural China using the super-SBM model and the Malmquist productivity index.Int J Equity Health. 2019; 18: 111Crossref PubMed Scopus (15) Google ScholarThere might be better strategies than universal screening available to help China achieve its goal of eliminating HBV as a public health threat by 2030. To find them, more analysis and efforts are needed. We declare no competing interests. This work was supported by the National Natural Science Foundation (72122001, 71934002). Cost-effectiveness of universal screening for chronic hepatitis B virus infection in China: an economic evaluationThe five-test universal screening strategy in people aged 18–70 years, implemented within the next 10 years, is the optimal HBV screening strategy for China. Other screening strategies could be cost-effective alternatives, if budget is limited in rural areas. Delaying strategy implementation reduces overall cost-effectiveness. Early screening initiation will aid global efforts in achieving viral hepatitis elimination. Full-Text PDF Open AccessThe optimal screening strategy for chronic hepatitis B virus infection in China – Authors' replyWe thank Min Liu and Jue Liu for taking the time to read our study and respond to our published manuscript.1 They suggest that hepatitis B virus (HBV) screening for key groups and groups at high risk might be a better strategy for China to achieve the 2030 HBV elimination target than by universal screening. Although targeted screening has its advantages in reducing the initial monetary investment and can be implemented in resource-scarce settings, identifying the key groups and groups at high risk themselves could be a major barrier for its implementation. Full-Text PDF Open Access